International journal of nursing studies
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Nursing staff caring for people with dementia have a crucial role in addressing palliative care needs and identifying changes in health status. Palliative care for people with dementia is complex and requires specific competences. A lack thereof may lead to unnecessary hospitalizations, poor symptom control and undesirable burdensome treatments. Understanding what nursing staff need to provide palliative care specifically for people with dementia facilitates the development of tailored and feasible interventions. ⋯ A comprehensive overview of nursing staff perspectives on providing palliative care for people with dementia demonstrates interdependent needs related to recognizing and addressing palliative care needs, communicating, handling challenging behaviour and building close care relationships. These care-related needs occur within workplace and organizational contexts. Organizational support is considered insufficient. Yet, healthcare organizations have the authority to fulfil a facilitating role in implementing nursing interventions tailored to nursing staff needs. Areas for further research include home care settings, the psychosocial and spiritual domains of palliative dementia care, advance care planning and family involvement.
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Review
Improving paediatric pain management in the emergency department: An integrative literature review.
Children presenting to the emergency department continue to experience suboptimal pain management. While evidence-based pain management interventions are available to clinicians, effective and sustainable practice change is yet to be achieved. This practice gap requires a collaborative approach to knowledge translation targeting systems of care. ⋯ The way forward is to respectfully engage all stakeholders-children, parents and clinicians-to collaboratively develop evidence-based, sustainable solutions aligned with the emergency department context. Guided by an implementation framework, future research designed to creatively translate evidence into practice and facilitate change at a systems level is a priority. Key to this solution is the integration of family involvement in pain management, considering child and family sensitive outcome measures. Effectiveness of new interventions should be evaluated in the short and long term to embed sustainable practice change. Frontline nurses are well placed to lead this transformation in paediatric pain management in the emergency department.
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The concept of health education has traditionally focused on enabling people to change unhealthy behaviours and lifestyles. Although, at the theoretical level, there exist definitions of the concept, it remains complex and ambiguous. Furthermore, nurses often confuse the concept with other related terms, such as health information or health promotion. The aim here is to report a concept analysis of health education and elucidate a current definition. ⋯ The theoretical definition and conceptual framework provided in this study contribute to and extend the current knowledge base among nurses and other health care providers. The findings elucidate the clinical role of health educators, enabling them to identify the realities of its practice, building a common reference point, and highlighting the main recommendations for its use at the clinical, education, policy and research interface.
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Despite widespread adoption of rapid response systems and the use of various early warning scoring systems, the detection of patient deterioration remains suboptimal, leading to the development of potentially avoidable serious adverse events. Why this occurs has been the focus of many investigations, but the complexities around advancing understanding that leads to effective actions are less evident. ⋯ Nurses aim to use early warning score systems to detect deterioration and ensure patient safety, however cultures, confidence and past experiences impact on rates of afferent limb failure globally. Simple to follow algorithms used in track and trigger charts are likely difficult for nurses to adhere to due to heavy workloads and challenges in getting medical officers to review within recommended time frames. Nurses rely heavily on the scores generated by early warning score systems but should aim to follow algorithms better and undertake holistic physical assessments to detect deterioration earlier and ensure patient safety is not compromised.
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Negative workplace behaviour among nurses is a globally recognised problem and new graduate nurses are at high risk for exposure. Negative behaviour has detrimental effects on new graduate nurses, the nursing profession and patients. ⋯ Negative workplace behaviour towards new graduate nurses continues to be an international problem. Available studies are descriptive and exploratory in nature and there have been few effective strategies implemented in acute care setting to address towards new graduate nurses. Multi-level organisational interventions are warranted to influence the 'civility norms' of the nursing profession. With a new understanding of the theoretical underpinnings of negative workplace behaviours towards new graduate nurses and the identification of limited intervention studies being undertaken, the nursing profession is provided with new directions in their future endeavours.